Study links community C difficile cases in kids to antibiotics
A study published this week in Pediatrics suggests that most Clostridium difficile infections in children are unrelated to hospitalization and that a majority of these community-associated cases involve children who recently received antibiotic treatment for unrelated conditions.
C difficile causes at least 250,000 infections in hospital patients and 14,000 deaths each year in adults and children, according to the Centers for Disease Control and Prevention (CDC), which was involved in the study. Antibiotics can reduce beneficial gut bacteria, allowing C difficile to flourish.
The authors used data from an active C difficile surveillance system covering 10 US regions to identify cases, defined as a positive stool test without a positive test in the previous 8 weeks. Community-associated cases were those in which stool was collected from outpatients or hospitalized patients within 3 days of admission.
Of 944 pediatric cases that were identified, 71% were community-associated. C difficile incidence per 100,000 children was highest among 1-year-olds (66.3) and white children (23.9). The share of cases with documented diarrhea (72%) or severe disease (8%) was similar across age-groups, and there were no deaths. Among 84 patients who were interviewed and who reported diarrhea on the day of stool collection, 73% had received antibiotics during the previous 12 weeks.
In a press release, the CDC said most of the children who had previously received antibiotics had been treated for ear, sinus, or upper respiratory infections. The agency said other studies have shown that at least 50% of antibiotics clinicians prescribe for children are for respiratory infections, most of which don't require antibiotics.
"When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C difficile infection and dangerous antibiotic resistant infections," CDC Director Tom Frieden, MD, MPH, commented in the release.
Mar 3 Pediatrics abstract
Mar 7 CDC press release
Report details GBS complication in likely Zika virus case
Researchers from French Polynesia yesterday reported what they call the first known case of Guillain-Barre syndrome (GBS) following a probable Zika virus infection, detailing their findings related to an outbreak in the region. The case is reported in the latest issue of Eurosurveillance.
The region is experiencing ongoing epidemics of Zika virus and dengue infections, and the authors noted that Zika virus illnesses are usually benign and rarely lead to hospitalization.
In a weekly communicable disease update today, the European Centre for Disease Prevention and Control (ECDC) estimated that more than 29,000 people in French Polynesia have sought medical care for Zika-like symptoms since the outbreak began in October. As of Feb 21, there were more than 8,500 suspected cases; 74 were in patients neurologic and autoimmune complications, including 41 with GBS.
The case report describes a woman in her early 40s who was hospitalized for neurologic symptoms, which included paresthesia in four extremities. Over the next few days she experienced more symptoms, including muscle weakness and bilateral but asymmetric facial palsy, consistent with GBS.
The medical work-up suggested that she had been sick with a flu-like illness about a week before the onset of her neurologic symptoms; her medical team suspected Zika fever because the outbreak was ongoing.
Further, serologic tests suggested a recent Zika virus infection, without cross-reactions suggestive of an earlier dengue infection, according to the report.
The authors said the case raises the possibility of GBS as a complication in Zika virus infections. Although the mechanism is unknown, it could resemble an immunologic pattern seen with other infectious agents, they noted, adding that the case could hint at a more pathogenic Zika genotype or increased susceptibility in the Polynesian population.
Mar 6 Eurosurveill report
Mar 7 ECDC weekly communicable disease threat report